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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT:to Web-App#
<br /> PROPERTY OWNER;.INFORMATION s71.,:_ ?�� 1;ugshirg. ., ,.x._:-J1,=,,?t r-:f*
<br /> OWNER NAM/ CUSTOMER TO PROVIDE
<br /> /l 2 ✓,I A. Z ,tg[.c o (/D c.._
<br /> OWNER ADDRESS (Number,Street,City,State,Zi
<br /> RI Zoning Status;CUP;
<br /> Js- 7y 4),"//0 u.. �i', v S��' 4 /o._ Cc,� _s-3 S, , Deed lance( ric ion;C M
<br /> HOME PHONE CELL PHONE Variance(# }f — )
<br /> E-MAIL ADDRESS
<br /> 6(5 - F77-0c/07 60Y-S7r-ylPi' %S,b4E/)i..Q all c., . c o.---- ® Site Plan drawn to scale
<br /> AGENT INFORMATION.-;:; CONTRACTOR INFORMATION ? and includes dimensions
<br /> AGENT NAME CONTRACTOR NAME
<br /> Ka%/)k 8(A-Q (o L-- © Site Plan including location
<br /> AGENT ADDRESS a
<br /> CONTRACTOR ADDRESS of well/septic
<br /> RW
<br /> /57 ,�/OG..- ,J .e
<br /> (City,State,Zip) (City,State,Zip) ® Setbacks
<br /> -s710ee;h 7,o, c,/.../7- S3 f src.
<br /> PHONE PHONE ® Site Plan approval from
<br /> G Ocitr— 8 7 ? -O yO") applicable township:
<br /> E-MAIL ADDRESS E-MAIL ADDRESS
<br /> ® Floor plans to scale
<br /> PROPERTY/LOCATION INFORMATION":,(http://accessdane.co:dane.wi.us/):;
<br /> PARENT PARCEL NUMBER: CURRENT ZONING: ACREAGE: 1 Elevation of property
<br /> LI NUMBER 3, S frontage drawn to scale. '
<br /> TOWNSHIP: SECTION:
<br /> /5/16;0,-- 7 %. Si.,,� w4 1/'/.: %StiAite' ® Driveway permits
<br /> ADDRESS: 5.„ (state,county,town)
<br /> /S-2 `j G✓/Z/o C`: L2c,'. e S'44),X /o A- (.4-4r5 3 S"S5 0 Sanitary
<br /> CSM: LOT SUBDIVISION BLOCK/LOT permits
<br /> 9 3 5 3 � (public,private)
<br /> PROPOSED PROJECT INFORMATION;
<br /> r IPROJECT DESCRIPTION: � s'
<br /> SfOr�z, m -S% ecf w a, ei
<br /> M This project is a new building or structure. a a;��',` 4
<br /> ❑This project is an addition/alteration to an existing building or structure.
<br /> SANITARY SERVICE: � 1? ry
<br /> PERMIT NUMBER: �n���pz� ',...2.1.;::;:.
<br /> � :,.. �
<br /> ❑SEWER ❑SEPTIC ,, � .rt , '-
<br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) - f - s .
<br /> AREA TO NEAREST SQUARE FOOT:
<br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ',. ; 1..1424--
<br /> BASEMENT: 1 ST FLOOR: ®���e ,,t ��„„
<br /> 4, TOTAL SQUARE FOOTAGE: 4, - Q _ ... �g°*
<br /> �; 1
<br /> 2ND FLOOR: 3RD FLOOR: ° �'
<br /> 5 O o S :
<br /> ESTIMATED CONSTRUCTION COST ,
<br /> _�- -
<br /> (Please round to nearest dollar) '♦ "♦ "� "♦ "♦ '"► � � "
<br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes 0 No ❑Don't know
<br /> 2. Is there a wetland or floodplain on or near the property? Li Yes ®No ❑Don't know
<br /> 3. Have you talked with the township about your project and are they in agreement'? Yes ❑No
<br /> 4. Has there been a zoning permit issued for this property in the past 5 years? ❑Yes ®No
<br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none)
<br /> 6. Is a location survey required? (see reverse) ❑Yes ❑No ErDon't know
<br /> 7. Is this to correct a violation? ❑Yes ®No
<br /> APPLICATION MUST BE SIGNED
<br /> 545-112(a/oa) (Continue on Back) —► -0 —0
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